Kerry HowleyCommunity Health NurseAge Concern Canterbury

Difficult to clearly define Many interdependencies and multi-

causal Problems may be unstable and continue

evolving Problems are socially complex and

many stakeholders No clear or correct solution Responsibility stretches across many

organisations Proposed measures may have

unforeseen effects

The accumulation of and failure to discard a large number of objects that seem to be useless or of limited value

Extensive clutter in living spaces that prevents the effective use of the spaces, and

Significant distress or impairment caused by hoarding

Squalor may be present in hoarding homes

There can be squalor without hoarding Squalor may result from rotting food,

animal or human waste, insect infestation or vermin

Offensive odours Home maintenance poor – plumbing,

wiring, structure of the home, roof etc Health risk to occupant(s) and visitors to

the home

Deprivation Grief and loss – Post Traumatic Stress

Disorder Learned behaviour Mental health

Major Depressive Disorder >50% ADD 30% and Hyperactivity 15% Anxiety 30% OCD 17% Social Phobia 30% Dementia – reduced cognitive ability Addictive personality – ETOH, collecting

Diagnostic and Statistical Manual of Mental Disorders due out in May 2013?

OCD classification currently Move to a separate classification in

DSM-5 Hoarding Disorder Is living in clutter a lifestyle choice?

Reclusive Socially awkward and isolated Embarrassed and/or ashamed Fear of authorities Resistant to enforced change Wanting help with the problem Wanting non-judgemental support

Falls, trips and injuries Becoming trapped by “stuff” Mould and mildew Respiratory problems Poor food hygiene and personal hygiene

Increased risk of infection, contamination Animals – diseases, excrement and urine Vermin – rats, mice Insects – fleas, cockroaches, flies, ants

etc. Fire risk

Increased risk of fatality

Increased response needed from fire service

Increased risk to emergency services if called to property

Increased risk to neighbours

Can occur in hoarding environments Person prioritises animals over

themselves Middle aged or older and 75% women Denial and minimisation of problems Unsanitary conditions due to animals Often identified following complaints

from neighbours Public expectations of SPCA Animal welfare is their primary concern

We don’t really know how many cases there are As statistics not collectedNo single point of entryCases with multiple agenciesLittle sharing or collaboration between

agenciesAnecdotally more cases since the

earthquakesPossible increase with ageing populationPossible increase with decrease in domestic

assistance

There is always a cost to helping the hoarderSupport workerRubbish disposal and/or skip hireStructural repairs to the homeTreatment for the person Garden maintenance and removal of green

waste Clients ability to pay The challenge of finding money Practitioner time spent finding funding Each practitioner working as individual What is the landlords responsibility?

Currently slow response Confusion as to who is responsible/lead

worker Earlier intervention better Assessment tools Team approach needed Need skilled workers, GP, psychologist,

social workers etc. Ongoing training and support for staff

working in this area

Clutter Image Rating Scale (CIR) http://stoppests.typepad.com/files/clutter-image-rating-scale-1.pdf

Activities of Daily Living – Hoarding (ADL-H)

http://www.cornellaging.org/gem/pdf/assessment_tool.pdf

Hoarding Rating Scale http://www.ocfoundation.org/uploadedFiles/Hoarding/Resources/

Hoarding%20Rating%20Scale%20with%20interpret.pdf

Important so that all practitioners and team are talking the same language

Preferably implemented nationally

Bring together a small group of interested people to coordinate management of cases

Modify assessment tools to suit NZ conditions Develop a factsheet for general distribution Single point of entry Identify funding sources Gather statistics Measure outcomes and successes Professional development and supervision for

people working with hoarding and squalor

App for Android or iPhones Squalor and Hoarding Toolkit http://

squalorandhoarding.catholiccommunityservices.com.au/

Working with People with Hoarding Behaviours (DVD)

Stuff Happens (Audio CD) Catholic Community Services – enquiries 1800 225 474

The Hoarding Handbook ISBN 978-0-19-538551-9

Most hoarders have a mental health condition which can be treated

Most people want help Treat client with respect How to decide when to intervene Plan assessment and treatment Involve other help and agencies Information sharing to support people